myBenefits

The highlights below are provided as general information. Coverage for eligible costs are based on the contract detail. Reasonable and customary rates will be applied. Select the benefit for additional coverage details.

Ambulance:
Reimbursed at 100% of the reasonable and customary charges.
Limited to one trip per benefit year.

Vision:
Reimbursed at 100% to maximum of $80 every 24 months for eye exam, and 100% to a maximum of $200 every 24 months for glasses or contact lenses.

Prescription Drugs:
Reimbursed at 80% to a maximum of $3,000 per benefit year.
Based on the NASA Formulary with a generic rider.

Health Practitioners:
Covered practitioners include: Acupuncturist, podiatrist/chiropodist, chiropractor, massage therapist, naturopath, dietitian, osteopath, physiotherapist, psychologist or registered social worker, and speech therapist. Practitioners must be registered and licensed in their field of practice. For detailing’s outlining amounts covered please visit supplemental health.

Medical Equipment & Supplies:
Overall maximum of $2000 per benefit year. A physician's prescription is required. Pre-authorization is suggested.

Dental Coverage:
Exams covered at 90% once per benefit year. Overall plan maximum of $900 per benefit year.

Dental Accident:
Reimbursed at 100% to a maximum of $1,000 per accident.
(services must be started within 90 days of accident and completed within 12 months of accident; authorization required)

Travel Insurance:
$5,000,000 of coverage for emergencies and illnesses while travelling.

Tutorial:
After 15 days of confinement due to illness or injury.

NOTE: In the event of any discrepancy between the information herein and our contract with the insurer, the terms of the contract will apply.

Diagnostic & Preventative
Your plan covers 90% of diagnostic and preventative procedures including
• Polishing or cleaning teeth, 2 units per benefit year
• Scaling, 2 units per benefit year, 6 additional units covered at 80%
• Recall, initial or complete examination, once per benefit year
• full mouth series of x-rays once in a 36 month period (not eligible for dependents under 12)
• Periapical, up to 16 films in a 36 month period.
• Bitewings, not more than 4 films per benefit year
• panoramic, 1 in any period of 36 months
• fluoride, 1 treatments per benefit year for dependants age 16 or younger.
• Oral hygiene instruction, 1 treatment per lifetime
• pit and fissure sealants, under 16 years of age, 1 molar in a period of 36 months
• space maintainers and maintenance, 1 per benefit year
• anaesthesia, eligible when done in conjunction with a covered dental procedure

Minor Restorative
Your plan covers 75% for services associated with dental health restoration, including:
• sedative, silver and white fillings(All restoration done to the same tooth will be covered as a single visit to the dentist)

Oral Surgery
Your plan covers 75% for services associated oral surgery, including:
• Residual Root Removal
• Extractions
• Alveoloplasty, Gingivoplasty, Stomatoplasty, Vestibuloplasty
• Surgical Excision
• Surgical Incision
• Fractures
• Frenectomy
• Post-Surgical care

Endodontic
Your plan covers 75% for endodontic services including:
• Pulpotomy
• root canal therapy (once per tooth)

Major Restorative
Your plan covers 75% of major restorative services including:
• Pins
• Crowns
• Posts

Limitations and Exclusions to Extended Health Benefits
No benefit is payable for:
1) expenses for which benefits are payable under a Workers' Compensation Act or a similar statute;
2) expenses incurred due to intentionally self-inflicted injuries;
3) expenses incurred due to civil disorder or war, whether or not war was declared;
4) expenses incurred due to committing a criminal offense or provoking an assault;
5) expenses for which benefits are payable under a government plan;
6) expenses for benefits which are legally prohibited by the government from coverage;
7) Services or supplies received outside of Canada;
8) expenses for drugs which, in the insurer's opinion, are experimental;
9) expenses for dietary supplements, vitamins and infant foods;
10) expenses for contraceptives (other than oral);
11) expenses for smoking cessation aids;
12) expenses for drugs if they are used for the treatment of infertility;
13) expenses for "in vitro" or "in vivo" procedures, or any other infertility procedures;
14) dental expenses, except those specifically provided under eligible expenses for treatment of accidental injuries to natural teeth;
15) utilization fees which are imposed by the Provincial Health Care Plan for the use of a service;
16) preventative immunization vaccines and toxoids; or
17) any other exclusion identified in the policy contract.

Limitations and Exclusions to Dental Benefits
No benefit is payable for:
1) any cause for which the insured may apply for and receive protection, exemption or compensation under any Workers' Compensation Act;
2) Dentures, bite plates, bridges, bleaching, orthodontic services
3) Any anesthesia administered in a hospital;
4) Any dental charges not included in the current provincial fee guide;
5) Any dental treatment for the correction of temporomandibular joint dysfunction;
6) any dental care, treatment or supplies primarily for cosmetic purposes;
7) any dental appliances including replacement of mislaid, lost or stolen appliances;
8) Endodontic treatment that started before the effective date of coverage;
9) procedures or supplies used in vertical dimension corrections (changing the height of the teeth) or to correct attrition problems (worn down teeth);
10) any dental treatment for the correction of temporomandibular joint dysfunction;
12) Any services or supplies for implantology, including tooth implantation and surgical insertion of fabricated implants; 13) Services or supplies received outside of Canada;
14) any other exclusion identified in the policy contract.

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Ambulance
Your plan covers of 100% of the reasonable and customary charges per occurrence for licensed ground ambulance or emergency air service that transports the patient to the nearest hospital equipped to provide the required treatment when the physical condition of the patient prevents the use of another means of transportation. If the patient requires the services of a registered nurse during the flight, the services and return airfare for a registered nurse are covered. Limited to one trip per benefit year.

Practitioners
The services of the following practitioners are covered at 90% up to $40 per visit to a maximum of $300 based on reasonable and customary charges, per practitioner, per benefit year.
- Acupuncture
- Podiatrist^/Chiropodist
- Chiropractor^
- Massage Therapist *
- Dietitian
- Osteopath^
- Physiotherapist / Athletic Therapist *
- Speech Therapist

*physician’s prescription/referral required for indicated services

The services of the following practitioners are covered at 90% to an overall plan maximum of $900 based on reasonable and customary charges, per benefit year.
- Psychologist or Registered Social Worker

The services of the following practitioners are covered at 90% up to $75 per visit to a maximum of $300 based on reasonable and customary charges, per practitioner, per benefit year.
- Naturopathic Consultations

^If an X-ray is recommended, an additional $25 is covered towards this expense.

Medical Services & Supplies
It is recommended that an application for pre-approval be submitted to the insurer for any item that would be claimed under the Medical Services & Supplies benefit.
Your plan covers a maximum of $2000 per student benefit year for medical equipment and supplies.

Medical Equipment
Your plan covers a maximum of $2000 per student benefit year for eligible medical equipment when prescribed by a physician. Eligible durable equipment includes, but is not limited to, items such as:

• wheelchairs (repairs, $250 per lifetime);
• respiratory equipment, including oxygen, maximum $1,500 per student year
• contact lenses/glasses following cataract surgery limit 1 pair per lifetime
• canes, crutches, walkers, casts, splints catheters
• compression stockings limit 2 pairs per student year
• blood glucose monitor, maximum $500 per student year
• insulin pumps, maximum $500 per lifetime
• Intra-Uterine Devices with no medicinal content limit1 per student year
• aero chamber limit 1 per student year
• custom-made rigid or semi-rigid braces (not for athletic use) for back, neck, arm or leg, maximum $1,000 per lifetime, per condition
• non-dental prostheses such as artificial limbs and eyes; including replacement if required due to a change in physical condition
• Hearing aids covered at 50% up to $500 every five years

Braces, Crutches, Splints, Trusses
Your plan covers 80% of reasonable and customary charges when prescribed by a physician and are not solely for athletic use for braces, crutches, splints, and trusses.

Prosthesis
Your plan covers 80% of reasonable and customary charges when prescribed by a physician for artificial limbs or other prosthetic appliances.

Orthopaedics*
Your plan covers 80% up to a maximum of $150 per benefit year for custom-fitted orthopaedic shoes, repairs and modifications when required for the correction of deformity of the bones and muscles. Provided the orthopaedics are not solely for athletic use and are prescribed by a physician, podiatrist, chiropodist, or chiropractor.

*IMPORTANT It is strongly recommended that a pre-determination/estimate be submitted to Canada Life to ensure that the guidelines set out by Canada Life for the payment of Orthopaedics are met and to confirm that your claim would be eligible.

Dental Accident
IMPORTANT! Dental Accident Pre-determination: An estimate for all dental accident services MUST be submitted to the health plan insurer. If you go ahead with treatment without a pre-determination being approved, you are doing so at the risk of the expenses being yours.

The plan covers 100% of the cost of the services of a dental surgeon, limited to the fees provided in the current General Practitioners fee guide, including dental prosthesis, required for the treatment of a fractured jaw or accidental injuries to natural teeth or jaw if caused by external, violent and accidental means. Services must be started within 90 days of accident and completed within 12 months of the accident. Dental Accident benefits are payable through the Health plan and limited to $1,000 per accident.